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Murugun G, Singh D, Selvamuthu N. A Case Series of Selective Nerve Root Block - A Technique for Delaying Surgery in Patients with Lumbar Radiculopathy. J Orthop Case Rep 2024; 14:222-227. [PMID: 39157495 PMCID: PMC11327665 DOI: 10.13107/jocr.2024.v14.i08.4704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/07/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction The aim of this research is to study the clinical outcome and symptomatic improvement for patients with lumbar radiculopathy treated with selective nerve root block (SNRB) under fluoroscopic guidance. This non-surgical management can be used at various sites including cervical and lumbar regions and also can prevent early surgeries for patients with radiculopathy. Materials and Methods Thirty patients with low back pain with or without sciatica were treated by fluoroscopic-guided nerve root block (F- NRB) as therapeutic management in government Cuddalore Medical College during the period of August 2020-2022. These patients were studied prospectively for the period of6 months and assessed with the Visual Analog Scale to quantify the severity ofpain. Discussion 30 patients underwent S-NRB, in that 26 patients had an immediate recovery and four patients showed delayed recovery, so that four patients underwent surgery. At the 3rd and 6th-month follow-up, 14 patients did not have a recurrence of pain and 12 had a recurrence of pain. Out of these 12 patients who had pain recurrence, only four needed surgery and the rest were managed conservatively. Accordingly, out of 30 patients who underwent SNRB, only eight patients needed surgery. Conclusion Patients with lumbar radiculopathy caused by lumbar disc prolapse and foraminal stenosis have good clinical outcomes by SNRB. This method had good pain relief for about 86% of patients immediately and prevented surgery for about 73.3% of patients. Out of 26.7% who underwent surgery, the majority had sequestrated discs. Thus, the sequestrated disc is one of the major negative predictors of successful outcomes for SNRB.
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Affiliation(s)
- Gurumoorthy Murugun
- Department of Orthopeadics, Rajah Muthiah Medical College, Government Cuddalore Medical College, Chidambaram, Tamil Nadu, India
| | - Dhanpal Singh
- Department of Orthopeadics, Rajah Muthiah Medical College, Government Cuddalore Medical College, Chidambaram, Tamil Nadu, India
| | - Naveen Selvamuthu
- Department of Orthopeadics, Rajah Muthiah Medical College, Government Cuddalore Medical College, Chidambaram, Tamil Nadu, India
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Costa M, Avila MJ, Vivanco-Suarez J, Karas P, Monteith S, Patel A. Minimally Invasive Technique for Chiari I Decompression Without Durotomy: Surgical Technique and Preliminary Case Series. World Neurosurg 2024; 188:e145-e154. [PMID: 38759783 DOI: 10.1016/j.wneu.2024.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Chiari I malformation, marked by severe headaches and potential brainstem/spinal cord issues, often requires surgical intervention when conservative methods fail. This study introduces a minimally invasive surgery (MIS) Chiari decompression technique utilizing a 3-blade retractor, aiming to reduce postoperative discomfort and optimize outcomes. METHODS Chiari type I malformation patients who underwent a MIS technique were included. Technique consisted of a minimal-soft tissue opening using a 3-blade retractor, suboccipital craniectomy, C1 laminectomy, and resection of the atlantooccipital band without a durotomy. RESULTS Ten patients were treated. Mean age was 43.3 years, with 7 female patients. All patients presented with occipital headaches; 50% retroorbital pain; 40% neck, upper back, or shoulder pain; and 30% limb paresthesias. Median pre-surgical modified Rankin Scale (mRS) was 3 (2-4) and pain visual analog score (VAS) was 7 (5-9). Mean operative time was 59 (59-71) minutes, with mean blood loss of 88.5 (50-140) mL. In our sample, 90% of patients were discharged the same surgical day (mean 7.2 [5.3-7.7] hours postoperative). No immediate or delayed postoperative complications were evidenced. At 6 months, 90% of patients had mRS 0-1. At last follow-up the mean VAS was 1.5 (range: 0-4, P < 0.001). CONCLUSIONS The MIS 3-blade flexible retractor technique for Chiari decompression is feasible, provides wide visualization angles of the suboccipital region and C1 arch, allows 2-surgeon work, and minimizes skin and soft tissue disruption. This combination may diminish postoperative discomfort, reduce the risk of surgical site infections, and optimize outcomes.
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Affiliation(s)
- Matias Costa
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA.
| | - Mauricio J Avila
- Division of Neurosurgery, Saint Louis University, St. Louis, Missouri, USA
| | - Juan Vivanco-Suarez
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Patrick Karas
- Department of Neurological Surgery, University of Texas Medical Branch, Texas, USA
| | - Stephen Monteith
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Akshal Patel
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
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Chin BZ, Yong JH, Wang E, Sim SI, Lin S, Wu PH, Hey HWD. Full-endoscopic versus microscopic spinal decompression for lumbar spinal stenosis: a systematic review & meta-analysis. Spine J 2024; 24:1022-1033. [PMID: 38190892 DOI: 10.1016/j.spinee.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND CONTEXT Symptomatic lumbar spinal stenosis is routinely treated with spinal decompression surgery, with an increasing trend towards minimally invasive techniques. Endoscopic decompression has emerged as a technique which minimizes approach-related morbidity while achieving similar clinical outcomes to conventional open or microscopic approaches. PURPOSE To assess the safety and efficacy of endoscopic versus microscopic decompression for treatment of lumbar spinal stenosis. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review on randomized and nonrandomized studies comparing endoscopic versus microscopic decompression was conducted, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Treatment effects were computed using pairwise random-effects meta-analysis. Risk of bias was assessed using the Cochrane Risk-of-bias and ROBINS-I tools for randomized and nonrandomized trials respectively. Quality of the overall body of evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS A total of 19 primary references comprising 1,997 patients and 2,132 spinal levels were included. Endoscopic decompression was associated with significantly reduced intraoperative blood-loss (weighted mean differences [WMD]=-33.29 mL, 95% CI:-51.80 to -14.78, p=.0032), shorter duration of hospital stay (WMD=-1.79 days, 95% CI: -2.63 to 0.95, p=.001), rates of incidental durotomy (RR = 0.63, 95% CI: 0.43 to 0.91, p=.0184) and surgical site infections (RR=0.23, 95% CI: 0.10 to-0.51, p=.001), and a nonsignificant trend towards less back pain, leg pain, and better functional outcomes compared to its microscopic counterpart up to 2-year follow up. CONCLUSIONS Endoscopic and microscopic decompression are safe and effective techniques for treatment of symptomatic lumbar spinal stenosis. Prospective studies of larger power considering medium to long-term outcomes and rates of iatrogenic instability are warranted to compare potential alignment changes and destabilization from either techniques.
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Affiliation(s)
- Brian Zhaojie Chin
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore.
| | - Jung Hahn Yong
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
| | - Eugene Wang
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
| | - Seth Ian Sim
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore
| | - Shuxun Lin
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, 609606, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
| | - Pang Hung Wu
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, 1 Jurong East St 21, 609606, Singapore
| | - Hwee Weng Dennis Hey
- Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Rd, 119228, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Rd, 119228, Singapore
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Bcharah G, Gupta N, Panico N, Winspear S, Bagley A, Turnow M, D'Amico R, Ukachukwu AEK. Innovations in Spine Surgery: A Narrative Review of Current Integrative Technologies. World Neurosurg 2024; 184:127-136. [PMID: 38159609 DOI: 10.1016/j.wneu.2023.12.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Neurosurgical technologies have become increasingly more adaptive, featuring real-time and patient-specific guidance in preoperative, intraoperative, and postoperative settings. This review offers insight into how these integrative innovations compare with conventional approaches in spine surgery, focusing on machine learning (ML), artificial intelligence, augmented reality and virtual reality, and spinal navigation systems. Data on technology applications, diagnostic and procedural accuracy, intraoperative times, radiation exposures, postoperative outcomes, and costs were extracted and compared with conventional methods to assess their advantages and limitations. Preoperatively, augmented reality and virtual reality have applications in surgical training and planning that are more immersive, case specific, and risk-free and have been shown to enhance accuracy and reduce complications. ML algorithms have demonstrated high accuracy in predicting surgical candidacy (up to 92.1%) and tailoring personalized treatments based on patient-specific variables. Intraoperatively, advantages include more accurate pedicle screw insertion (96%-99% with ML), enhanced visualization, reduced radiation exposure (49 μSv with O-arm navigation vs. 556 μSv with fluoroscopy), increased efficiency, and potential for fewer intraoperative complications compared with conventional approaches. Postoperatively, certain ML and artificial intelligence models have outperformed conventional methods in predicting all postoperative complications of >6000 patients as well as predicting variables contributing to in-hospital and 90-day mortality. However, applying these technologies comes with limitations, such as longer operative times (up to 35.6% longer) with navigation, dependency on datasets, costs, accessibility, steep learning curve, and inherent software malfunctions. As these technologies advance, continuing to assess their efficacy and limitations will be crucial to their successful integration within spine surgery.
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Affiliation(s)
- George Bcharah
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Nithin Gupta
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Nicholas Panico
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Spencer Winspear
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Austin Bagley
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Morgan Turnow
- Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
| | - Randy D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA
| | - Alvan-Emeka K Ukachukwu
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA; Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA.
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Bardeesi A, Tabarestani TQ, Bergin SM, Huang CC, Shaffrey CI, Wiggins WF, Abd-El-Barr MM. Using Augmented Reality Technology to Optimize Transfacet Lumbar Interbody Fusion: A Case Report. J Clin Med 2024; 13:1513. [PMID: 38592365 PMCID: PMC10934424 DOI: 10.3390/jcm13051513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
The transfacet minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a novel approach available for the management of lumbar spondylolisthesis. It avoids the need to manipulate either of the exiting or traversing nerve roots, both protected by the bony boundaries of the approach. With the advancement in operative technologies such as navigation, mapping, segmentation, and augmented reality (AR), surgeons are prompted to utilize these technologies to enhance their surgical outcomes. A 36-year-old male patient was complaining of chronic progressive lower back pain. He was found to have grade 2 L4/5 spondylolisthesis. We studied the feasibility of a trans-Kambin or a transfacet MIS-TLIF, and decided to proceed with the latter given the wider corridor it provides. Preoperative trajectory planning and level segmentation in addition to intraoperative navigation and image merging were all utilized to provide an AR model to guide us through the surgery. The use of AR can build on the safety and learning of novel surgical approaches to spine pathologies. However, larger high-quality studies are needed to further objectively analyze its impact on surgical outcomes and to expand on its application.
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Affiliation(s)
- Anas Bardeesi
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | | | - Stephen M. Bergin
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | - Chuan-Ching Huang
- Department of Neurosurgery, Duke University Hospital, Durham, NC 27710, USA
| | | | - Walter F. Wiggins
- Department of Radiology, Duke University Hospital, Durham, NC 27710, USA
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Wu CY, Huang HM, Lee HC, Tang CH, Chen YH, Chiu CD. Transforaminal Unilateral Biportal Endoscopic Spinal Surgery for Extraforaminal Lumbar Disc Herniation: A Retrospective Observational Study. World Neurosurg 2024; 183:e658-e667. [PMID: 38181875 DOI: 10.1016/j.wneu.2023.12.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Biportal endoscopic spinal surgery (BESS) is recommended as a safer and less destructive option for lumbar disc herniations. However, limited data exist on clinical outcomes for extraforaminal lumbar disc herniation (ELDH) surgery. This retrospective study presents our preliminary experience with transforaminal unilateral BESS for ELDH. METHODS Patients with lumbar radiculopathy refractory to conservative treatment, diagnosed with ELDH by magnetic resonance imaging, and treated with transforaminal unilateral BESS in 2021-2023 in 2 institutions in Taiwan were eligible for inclusion. Those with lumbar spondylolisthesis grade 2 or more with segmental instability, history of drug abuse or psychiatric diseases, or with a follow-up duration <1 year were excluded. Primary outcomes included visual analog scale for pain, assessed at 1 week, 1 month, 6 months, and 1 year using generalized estimating equations analysis; success and satisfaction of BESS graded by the Macnab criteria; and perioperative complications. Secondary outcomes were operative time and hospital length of stay. RESULTS Seventeen patients were included in the analysis, with a mean age of 65.8 years; 11 (64.7%) were males and 15 (88.2%) had no prior lumbar spine surgery. mean operative time was 107.9 minutes, and length of stay was 3.5 days. Graded by Macnab criteria, 16 (94.1%) of patients had good to excellent outcomes. Only 1 patient experienced complications. No recurrence/reoperation was observed. Generalized estimating equations analysis showed that postoperative visual analog scale scores decreased significantly at 1 week (adjusted Beta [aBeta] = -5.47, standard error: 0.29, P < 0.001), 1 month (aBeta = -5.82), 6 months (aBeta = -5.88), and 1 year (aBeta = -6.29). CONCLUSIONS Transforaminal unilateral BESS is an alternative and feasible method for treating ELDH, producing good surgical outcomes with few complications and sustaining pain improvement. Future studies with larger patient numbers and comparisons between BESS and other minimally invasive techniques for ELDH are warranted.
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Affiliation(s)
- Chih-Ying Wu
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Neurosurgery, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan; Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
| | - Hsiang-Ming Huang
- Department of Neurosurgery, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Han-Chung Lee
- Neuroscience Center, Everan Hospital, Taichung, Taiwan
| | - Chih-Hsin Tang
- Graduate Institute of Biomedical Science, College of Medicine, China Medical University, Taichung, Taiwan; Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Health Science, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Di Chiu
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Science, College of Medicine, China Medical University, Taichung, Taiwan; Spine Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
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Santos DE, Bozkurt I, Nurmukhametov R, Dosanov M, Volovish A, Chmutin G, Sierra AT, Eneliz B, Bernard E, Nakry P, Scalia G, Chaurasia B. The future of minimally invasive spine surgery in low-income Latin American countries. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2024; 60:35. [DOI: https:/doi.org/10.1186/s41983-024-00814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/15/2024] [Indexed: 04/10/2024] Open
Abstract
AbstractTreatment of spinal disorders can be managed conservatively or surgically. With the trend toward minimalistic approaches, minimally invasive spinal surgery (MISS) has gained much more importance over the last decade. Its use along with the required training has tremendously increased in developed countries. However, the availability of MISS today is uneven in different regions due to the development and availability of technology, as well as the level of training and qualifications of surgeons who are able to perform such operations on the spine. The purpose of this article is to analyze the prospects for minimally invasive spine surgery in Latin America in comparison with higher income countries.
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Landriel F, Padilla Lichtenberger F, Guiroy A, Soto M, Molina C, Hem S. Minimally Invasive Approaches for Lumbosacral Plexus Schwannomas. Oper Neurosurg (Hagerstown) 2024; 26:149-155. [PMID: 37831977 DOI: 10.1227/ons.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/16/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Lumbosacral plexus schwannomas (LSPSs) are benign, slow-growing tumors that arise from the myelin sheath of the lumbar or sacral plexus nerves. Surgery is the treatment of choice for symptomatic LSPSs. Conventional retroperitoneal or transabdominal approaches provide wide exposure of the lesion but are often associated with complications in the abdominal wall, lumbar or sacral plexus, ureter, and intraperitoneal organs. Advances in technology and minimally invasive (MIS) techniques have provided alternative approaches with reliable efficacy compared with traditional open surgery. We describe 3 MIS approaches using tubular retractor systems according to the lesion level. METHODS This was a multicenter, retrospective observational cohort study to evaluate the use of MIS tubular approaches for surgical resection of LSPSs. We included 23 lumbar and upper sacral plexus schwannomas. Clinical presentation, spinal level, surgical duration, degree of resection, days of hospitalization, pathological anatomy of the tumor, approach-related surgical difficulties, and outcomes were collected. RESULTS The posterior oblique approach was used in 43.5% of the cases, the transpsoas approach in 39.1%, and the transiliac in 17.4%. The mean operative time was 3.3 hours, and the mean hospitalization was 2.5 days. All tumors were WHO grade 1 schwannoma. Postoperative MRI confirms gross total resection in 91.3% of the patients. No patient requires instrumentation. The pros and cons of each approach were summarized. CONCLUSION The MIS approaches adapted to the lumbar level may improve surgeons' comfort allowing a safe resection of retroperitoneal LSPS.
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Affiliation(s)
- Federico Landriel
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
| | | | - Alfredo Guiroy
- Elite Spine Health and Wellness, Fort Lauderdale , Florida , USA
| | - Manuel Soto
- Spine Clinic, The American-British Cowdray Medical Center I.A.P., Mexico City , Mexico
| | - Camilo Molina
- Neurosurgical Department, Spine Unit, Washington University School of Medicine in St. Louis, St. Louis , Washington , USA
| | - Santiago Hem
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires , Argentina
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Tabarestani TQ, Wang TY, Sykes DAW, Mehta VA, Yang LZ, Chow SC, Shaffrey CI, Wiggins WF, Chi JH, Abd-El-Barr MM. Two-Year Clinical and Radiographic Outcomes for Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambin's Triangle Without Facetectomy. Int J Spine Surg 2023; 17:760-770. [PMID: 37553259 PMCID: PMC10753344 DOI: 10.14444/8540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND There has been heightened interest in performing percutaneous lumbar interbody fusions (percLIFs) through Kambin's triangle, an anatomic corridor allowing entrance into the disc space. However, due to its novelty, there are limited data regarding the long-term benefits of this procedure. Our objective was to determine the long-term efficacy and durability of the percutaneous insertion of an expandable titanium cage through Kambin's triangle without facetectomy. METHODS A retrospective review of patients undergoing percLIF via Kambin's triangle using an expandable titanium cage was performed. Demographics, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), radiographic measurements, perioperative variables, and complications were recorded. VAS, ODI, and radiographic measurements were compared with baseline using the generalized estimating equations assuming normally distributed data. Fusion was assessed with computed tomography (CT) at 1 and 2 years after the procedure. RESULTS A total of 49 patients were included. Spondylolisthesis, lumbar lordosis (LL), sacral slope, pelvic tilt, and anterior/posterior disc space height were all significantly improved postoperatively at each time point of 3, 6, 12, and 24 months (P < 0.001). Pelvic incidence-LL mismatch decreased significantly at each follow-up (P < 0.001) with a mean reduction of 4° by 24 months. VAS back scores reduced by >2 points at the 6, 12, and 24 month follow-ups. ODI scores reduced by >15 points at the 12- and 24-month follow-ups. Of the patients who had 1- and 2-year CT images, fusion rates at those time points were 94.4% (17/18) and 87.5% (7/8), respectively. The mean annual rate of surgically significant adjacent segment disease was 2.74% through an average follow-up of 2.74 years. CONCLUSION These results highlight that percLIF, a procedure done without an endoscope or facetectomy, can be performed using an expandable titanium cage through Kambin's triangle with excellent radiographic and clinical results. CLINICAL RELEVANCE percLIF via Kambin's triangle is a safe and succesful procedure with long-term improvements in both clinical and radiographic outcomes. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Troy Q Tabarestani
- Duke University School of Medicine, Duke University Hospital, Durham, NC, USA
| | - Timothy Y Wang
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - David A W Sykes
- Duke University School of Medicine, Duke University Hospital, Durham, NC, USA
| | - Vikram A Mehta
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Lexie Z Yang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Walter F Wiggins
- Department of Radiology, Duke University Hospital, Durham, NC, USA
| | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
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Hersh AM, Jimenez AE, Pellot KI, Gong JH, Jiang K, Khalifeh JM, Ahmed AK, Raad M, Veeravagu A, Ratliff JK, Jain A, Lubelski D, Bydon A, Witham TF, Theodore N, Azad TD. Contemporary Trends in Minimally Invasive Sacroiliac Joint Fusion Utilization in the Medicare Population by Specialty. Neurosurgery 2023; 93:1244-1250. [PMID: 37306413 DOI: 10.1227/neu.0000000000002564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Sacroiliac (SI) joint dysfunction constitutes a leading cause of pain and disability. Although surgical arthrodesis is traditionally performed under open approaches, the past decade has seen a rise in minimally invasive surgical (MIS) techniques and new federally approved devices for MIS approaches. In addition to neurosurgeons and orthopedic surgeons, proceduralists from nonsurgical specialties are performing MIS procedures for SI pathology. Here, we analyze trends in SI joint fusions performed by different provider groups, along with trends in the charges billed and reimbursement provided by Medicare. METHODS We review yearly Physician/Supplier Procedure Summary data from 2015 to 2020 from the Centers for Medicare and Medicaid Services for all SI joint fusions. Patients were stratified as undergoing MIS or open procedures. Utilization was adjusted per million Medicare beneficiaries and weighted averages for charges and reimbursements were calculated, controlling for inflation. Reimbursement-to-charge (RCR) ratios were calculated, reflecting the proportion of provider billed amounts reimbursed by Medicare. RESULTS A total of 12 978 SI joint fusion procedures were performed, with the majority (76.5%) being MIS procedures. Most MIS procedures were performed by nonsurgical specialists (52.1%) while most open fusions were performed by spine surgeons (71%). Rapid growth in MIS procedures was noted for all specialty categories, along with an increased number of procedures offered in the outpatient setting and ambulatory surgical centers. The overall RCR increased over time and was ultimately similar between spine surgeons (RCR = 0.26) and nonsurgeon specialists (RCR = 0.27) performing MIS procedures. CONCLUSION Substantial growth in MIS procedures for SI pathology has occurred in recent years in the Medicare population. This growth can largely be attributed to adoption by nonsurgical specialists, whose reimbursement and RCR increased for MIS procedures. Future studies are warranted to better understand the impact of these trends on patient outcomes and costs.
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Affiliation(s)
- Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Adrian E Jimenez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | | | - Jung Ho Gong
- The Warren Alpert Medical School of Brown University, Providence , Rhode Island , USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Jawad M Khalifeh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Micheal Raad
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford , California , USA
| | - Amit Jain
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
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Latka K, Kolodziej W, Domisiewicz K, Pawus D, Olbrycht T, Niedzwiecki M, Zaczynski A, Latka D. Outpatient Spine Procedures in Poland: Clinical Outcomes, Safety, Complications, and Technical Insights into an Ambulatory Spine Surgery Center. Healthcare (Basel) 2023; 11:2944. [PMID: 37998436 PMCID: PMC10671563 DOI: 10.3390/healthcare11222944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE This study evaluated the safety and efficacy of spine procedures performed in an ambulatory spine surgery unit in Poland. PATIENTS AND METHODS We conducted a retrospective analysis of 318 patients who underwent ambulatory spine surgery between 2018 and 2021, with procedures including microdiscectomy (MLD), anterior cervical discectomy and fusion (ACDF), endoscopic interbody fusion (endoLIF), posterior endoscopic cervical discectomy (PECD), interlaminar endoscopic lumbar discectomy IELD, and transforaminal endoscopic lumbar discectomy (TELD). Patient data were analyzed for pre-operative and post-operative visual analog scale (VAS) scores. RESULTS The findings indicated that outpatient techniques were safe and effective, with a 2.83% complication rate. All procedures significantly improved VAS scores under short-term observation, and core outcome measurement index (COMI) scores under long-term observation. CONCLUSIONS Ambulatory spine surgery represents a relatively new approach in Poland, with only a select few centers currently offering this type of service. Outpatient spine surgery is a safe, effective, and cost-effective option for patients requiring basic spine surgeries.
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Affiliation(s)
- Kajetan Latka
- Department of Neurosurgery, The St. Hedwig’s Regional Specialist Hospital, 45-221 Opole, Poland
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland; (W.K.); (T.O.); (D.L.)
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, 45-064 Opole, Poland; (K.D.); (M.N.)
| | - Waldemar Kolodziej
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland; (W.K.); (T.O.); (D.L.)
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, 45-064 Opole, Poland; (K.D.); (M.N.)
| | - Kacper Domisiewicz
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, 45-064 Opole, Poland; (K.D.); (M.N.)
| | - Dawid Pawus
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland;
| | - Tomasz Olbrycht
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland; (W.K.); (T.O.); (D.L.)
| | - Marcin Niedzwiecki
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, 45-064 Opole, Poland; (K.D.); (M.N.)
- Department of Neurosurgery, The National Institute of Medicine of the Ministry of Internal Affairs and Administration, 02-507 Warsaw, Poland;
| | - Artur Zaczynski
- Department of Neurosurgery, The National Institute of Medicine of the Ministry of Internal Affairs and Administration, 02-507 Warsaw, Poland;
| | - Dariusz Latka
- Department of Neurosurgery, Institute of Medical Sciences, University of Opole, 45-040 Opole, Poland; (W.K.); (T.O.); (D.L.)
- Center for Minimally Invasive Spine and Peripheral Nerve Surgery neurochirurg.opole.pl, 45-064 Opole, Poland; (K.D.); (M.N.)
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12
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Sultana T, Hossain M, Jeong JH, Im S. Comparative Analysis of Radiologic Outcomes Between Polyetheretherketone and Three-Dimensional-Printed Titanium Cages After Transforaminal Lumbar Interbody Fusion. World Neurosurg 2023; 179:e241-e255. [PMID: 37611804 DOI: 10.1016/j.wneu.2023.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Transforaminal lumbar interbody fusion (TLIF) is performed worldwide with polyetheretherketone (PEEK) and titanium (Ti) cages for the treatment of degenerative lumbar diseases. The aim of this study was to compare radiologic outcomes between a PEEK and three-dimensional-printed titanium (3DP-Ti) cage after TLIF with >1 year of follow-up. METHODS A total of 140 patients with degenerative lumbar diseases who underwent TLIF operation were included in this study. Intervertebral disc height and whole lumbar lordosis were measured and evaluated from the preoperative stage to the final follow-up. Subsidence of the cage was indicated if the cage sunk into the adjacent vertebral body or if there was a reduction in height of the fused segment by ≥3 mm during the postoperative follow-up. Migration of the cage was determined as the displacement of the interbody cage by ≥2 mm during the postoperative period. Fusion status was assessed at the 1 year and final follow-up using standard methods. RESULTS Both disc height and lumbar lordosis were well maintained throughout the study period, and no significant differences were observed between PEEK and 3DP-Ti groups. Both PEEK and 3DP-Ti cages demonstrated low rates of cage subsidence, with no significant difference was noted. A significant cage migration rate was observed in the PEEK group and the revision operation was required for 2 patients. The fusion rate of this study was not found to be statistically significant, although the 3DP-Ti cage was known to have an improved fusion rate than PEEK cage after lumbar interbody fusion. CONCLUSIONS Radiologic results suggest that the 3DP-Ti cage may be a better interbody cage for TLIF than is the PEEK cage.
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Affiliation(s)
- Tamima Sultana
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Mosharraf Hossain
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Soobin Im
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea.
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13
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Whitaker CD, Stone BK, Gregorczyk JA, Alsoof D, Hardacker K, Diebo BG, Daniels A, Basques B. Nonsurgical Interventional Spine Pain Procedures: Outcomes and Complications. JBJS Rev 2023; 11:01874474-202304000-00003. [PMID: 37058581 DOI: 10.2106/jbjs.rvw.22.00235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
» Nonsurgical interventional spine pain procedures provide an additional treatment option for lower back pain at the traditional bifurcation of conversative vs. operative management. » Transforaminal epidural steroid injections, radiofrequency ablations, intrathecal drug delivery, and spinal cord stimulation were found to be effective and safe techniques when applied to their specific indication. » Thermal annuloplasty and minimally invasive lumbar decompression showed mixed support. » Discography, sacroiliac joint injections, and spinous process spacers lacked sufficient evidence to support efficacy. » Medial branch blocks and facet joint injections were found to be useful diagnostic tools.
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Affiliation(s)
- Colin D Whitaker
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Benjamin K Stone
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kyle Hardacker
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bassel G Diebo
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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14
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Bamps S, Raymaekers V, Roosen G, Put E, Vanvolsem S, Achahbar SE, Meeuws S, Wissels M, Plazier M. Lateral Lumbar Interbody Fusion (Direct Lateral Interbody Fusion/Extreme Lateral Interbody Fusion) versus Posterior Lumbar Interbody Fusion Surgery in Spinal Degenerative Disease: A Systematic Review. World Neurosurg 2023; 171:10-18. [PMID: 36521760 DOI: 10.1016/j.wneu.2022.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Degenerative diseases of the lumbar spine are often treated with posterior interbody fusion surgery (posterior lumbar interbody fusion [PLIF]) for spinal instability or intractable back pain with neurologic impairment. Several lateral, less invasive procedures have recently been described (lateral lumbar interbody fusion [LLIF]/direct lateral interbody fusion/extreme lateral interbody fusion [XLIF]). The aim of this systematic review is to compare structural and functional outcomes of lateral surgical approaches to PLIF. METHODS We conducted a MEDLINE (PubMed), Web of Science, ScienceDirect, and Cochrane Library search for studies focusing on outcomes and complications comparing LLIF (direct lateral interbody fusion/XLIF) and PLIF. The systematic review was reported using the PRISMA criteria. RESULTS In total, 1000 research articles were identified, of which 5 studies were included comparing the outcomes and complications between the lateral and posterior approach. Three studies found significantly less perioperative blood loss with a lateral approach. Average hospital stay was shorter in populations who underwent the lateral approach compared with PLIF. Functional outcomes (visual analog scale score/Oswestry Disability Index) were similar or better with LLIF. In most of the included studies, complication rates did not differ between the posterior and lateral approach. Most of the neurologic deficits with XLIF/LLIF were temporary and healed completely within 1 year follow-up. CONCLUSIONS A lateral approach (XLIF/LLIF) is a good and safe alternative for PLIF in single-level degenerative lumbar diseases, with comparable functional outcomes, shorter hospital stays, and less blood loss. Future prospective studies are needed to establish the role of lateral minimally invasive approaches in spinal degenerative surgery.
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Affiliation(s)
- Sven Bamps
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium.
| | - Vincent Raymaekers
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium; Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Gert Roosen
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Eric Put
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Steven Vanvolsem
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Salah-Eddine Achahbar
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Sacha Meeuws
- Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium; Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Maarten Wissels
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium
| | - Mark Plazier
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Study and Training Center Neurosurgery, Virga Jesse, Hasselt, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
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15
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Shahi P, Dalal S, Shinn D, Song J, Araghi K, Melissaridou D, Sheha E, Dowdell J, Iyer S, Qureshi SA. Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups. Neurosurg Focus 2023; 54:E4. [PMID: 36587410 DOI: 10.3171/2022.10.focus22604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/18/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The goal of this study was to assess the outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients ≥ 70 years old and compare them to younger age groups. METHODS This was a retrospective study of data that were collected prospectively. Patients who underwent primary single-level MI-TLIF were included and divided into 3 groups: age < 60, 60-69, and ≥ 70 years. The outcome measures were as follows: 1) patient-reported outcome measures (PROMs) (i.e., visual analog scale [VAS] for back and leg pain, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey Physical Component Summary [SF-12 PCS]); 2) minimum clinically important difference (MCID) achievement; 3) return to activities; 4) opioid discontinuation; 5) fusion rates; and 6) complications/reoperations. RESULTS A total of 147 patients (age < 60 years, 62; 60-69 years, 47; ≥ 70 years, 38) were included. All the groups showed significant improvements in all PROMs at the early (< 6 months) and late (≥ 6 months) time points and there was no significant difference between the groups. Although MCID achievement rates for VAS leg and ODI were similar, they were lower in the ≥ 70-year-old patient group for VAS back and SF-12 PCS. Although the time to MCID achievement for ODI and SF-12 PCS was similar, it was greater in the ≥ 70-year-old patient group for VAS back and leg. There was no significant difference between the groups in terms of return to activities, opioid discontinuation, fusion rates, and complication/reoperation rates. CONCLUSIONS Although patients > 70 years of age may be less likely and/or take longer to achieve MCID compared to their younger counterparts, they show an overall significant improvement in PROMs, a similar likelihood of returning to activities and discontinuing opioids, and comparable fusion and complication/reoperation rates following MI-TLIF.
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Affiliation(s)
- Pratyush Shahi
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and
| | - Sidhant Dalal
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and
| | - Daniel Shinn
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and
| | - Junho Song
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and
| | - Kasra Araghi
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and
| | | | - Evan Sheha
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and
| | - James Dowdell
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and
| | - Sravisht Iyer
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York
| | - Sheeraz A Qureshi
- 1Department of Spine Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York
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16
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Endoscopic Rhizotomy for Facetogenic Back Pain: A Review of the History, Financial Considerations, Patient Selection Criteria, and Clinical Outcomes. World Neurosurg 2023; 169:36-41. [PMID: 36220495 DOI: 10.1016/j.wneu.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chronic back pain (CBP) is a condition that places a considerable burden on society, with several million people affected in the United States alone. Treatment options to address this problem and relieve CBP are constantly evolving, and one of the most promising treatment modalities for CBP that is refractory to conservative treatment options is endoscopic rhizotomy (ER). METHODS A thorough search of the PubMed (MEDLINE) database was conducted to assess the full progression of ER from its earliest uses to present day in a historical narrative review of ER, with treatment of facetogenic pain as a model pathology. RESULTS ER allows for direct visualization and ablation of sensory branches of the dorsal ramus to provide pain relief in up to 80% of patients faced with refractory CBP. This technique has been built upon since the early 20th century, and the novel endoscopic approach continues to gain popularity among physicians. Benefits of ER include superior postoperative median pain-free duration compared with traditional percutaneous radiofrequency ablation, as well as direct visualization of regional anatomy. Patient selection criteria for the procedure and a modest list of contraindications allow the use of ER as a viable treatment option for a significant population of patients suffering from CBP. Potential barriers to ER include high cost of the procedure, longer intraoperative time, and expensive proprietary equipment. CONCLUSIONS ER is an effective treatment for refractory CBP with notable advantages. As the technology and popularity of this procedure progress, improvements in the cost, training, and intraoperative time may make it a favorable alternative to the current standard of care.
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17
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Chun YM, Lee SH, Moon KS, Chang MC. Treatment of dural tear with nerve root herniation after unilateral biportal endoscopic decompression using an epidural blood patch: a case report. J Int Med Res 2022; 50:3000605221144147. [PMID: 36545840 PMCID: PMC9793011 DOI: 10.1177/03000605221144147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We present a case of a dural tear associated with nerve root herniation following unilateral biportal endoscopic decompression (UBED) that was successfully treated using a computed tomography-guided epidural blood patch. A 60-year-old man underwent UBED for radicular pain because of spinal stenosis at L4-5. A left partial hemilaminectomy and flavectomy were performed; however, the left dorsolateral side dura mater was torn during the procedure. TachoComb® was applied at the dural tear site, and the pain was relieved following UBED. However, 3 weeks post-UBED, the patient reported severe pain with an electric shock-like sensation in the left buttock and posterior thigh region with no other neurologic symptoms. The pain was aggravated by standing and spinal motion. Follow-up lumbar spinal magnetic resonance imaging was performed. Axial images indicated protrusion of the left S2 nerve root through the left dorsolateral side of the dura mater. The patient was further diagnosed with nerve root herniation following a dura mater tear. A computed tomography-guided epidural blood patch was performed, with successful therapeutic results. The outcome of this study indicates that a small dural tear that occurs during minimally invasive spinal surgery can be efficiently treated using an epidural blood patch prior to open surgery.
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Affiliation(s)
- Yoon Mok Chun
- Department of Physical Medicine and Rehabilitation, Wooridul
Spine Hospital, Gimpo Airport, Seoul, Republic of Korea
| | - Sang Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul,
Republic of Korea
| | - Kang Suk Moon
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul,
Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of
Medicine, Yeungnam University, Daegu, Republic of Korea,Min Cheol Chang, Department of Physical
Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1,
Daemyungdong, Namku, Taegu 705-717, Republic of Korea.
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Lucke-Wold B, Cerillo JL, Becsey AN, Chernicki BP, Root KT. Minimally Invasive Procedures, Perioperative Telemedicine, and Decreased Hospital Stays Following Covid-19 Surgical Restrictions: Spinal Surgery. ARCHIVES OF MEDICAL CASE REPORTS AND CASE STUDY 2022; 6:153. [PMID: 36844926 PMCID: PMC9956112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The 2019 severe acute respiratory syndrome coronavirus 2 pandemic had devastating impacts on healthcare system operations. Disruption of this delicate system led to international healthcare challenges with new policy changes that affected all specialties, including the global spine surgery community. The pandemic disrupted normal spine surgery proceedings, restricting, and postponing elective procedures, which comprise a large proportion of spine surgeries. This disruption may have contributed to significant economic losses for providers and resulted in the prolonged impairment of patients who were forced to postpone their procedures. However, response to the pandemic precipitated new procedural guidelines and practices that prioritize health outcomes and satisfaction. These new changes and innovations are positioned to provide lasting economic and procedural impacts in favor of both providers and patients. Thus, the objective of our review is to explore how spinal surgical practices and post-op recovery changed following COVID-19 and highlight some lasting impacts the pandemic created for future patients.
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Affiliation(s)
| | - John L Cerillo
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, FL, USA
| | | | - Brendan P Chernicki
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, FL, USA
| | - Kevin T Root
- College of Medicine, University of Florida, Gainesville, Florida, USA
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19
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Shahi P, Song J, Dalal S, Melissaridou D, Shinn DJ, Araghi K, Mai E, Sheha E, Dowdell J, Qureshi SA, Iyer S. Improvement following minimally invasive lumbar decompression in patients 80 years or older compared with younger age groups. J Neurosurg Spine 2022; 37:828-835. [PMID: 35901712 DOI: 10.3171/2022.5.spine22361] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to assess the outcomes of minimally invasive lumbar decompression in patients ≥ 80 years of age and compare them with those of younger age groups. METHODS This was a retrospective cohort study. Patients who underwent primary unilateral laminotomy for bilateral decompression (ULBD) (any number of levels) and had a minimum of 1 year of follow-up were included and divided into three groups by age: < 60 years, 60-79 years, and ≥ 80 years. The outcome measures were 1) patient-reported outcome measures (PROMs) (visual analog scale [VAS] back and leg, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey [SF-12] Physical Component Summary [PCS] and Mental Component Summary [MCS] scores, and Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF]); 2) percentage of patients achieving the minimal clinically important difference (MCID) and the time taken to do so; and 3) complications and reoperations. Two postoperative time points were defined: early (< 6 months) and late (≥ 6 months). RESULTS A total of 345 patients (< 60 years: n = 94; 60-79 years: n = 208; ≥ 80 years: n = 43) were included in this study. The groups had significantly different average BMIs (least in patients aged ≥ 80 years), age-adjusted Charlson Comorbidity Indices (greatest in the ≥ 80-year age group), and operative times (greatest in 60- to 79-year age group). There was no difference in sex, number of operated levels, and estimated blood loss between groups. Compared with the preoperative values, the < 60-year and 60- to 79-year age groups showed a significant improvement in most PROMs at both the early and late time points. In contrast, the ≥ 80-year age group only showed significant improvement in PROMs at the late time point. Although there were significant differences between the groups in the magnitude of improvement (least improvement in ≥ 80-year age group) at the early time point in VAS back and leg, ODI, and SF-12 MCS, no significant difference was seen at the late time point except in ODI (least improvement in ≥ 80-year group). The overall MCID achievement rate decreased, moving from the < 60-year age group toward the ≥ 80-year age group at both the early (64% vs 51% vs 41% ) and late (72% vs 58% vs 52%) time points. The average time needed to achieve the MCID in pain and disability increased, moving from the < 60-year age group toward the ≥ 80-year age group (2 vs 3 vs 4 months). There was no significant difference seen between the groups in terms of complications and reoperations except in immediate postoperative complications (5.3% vs 4.8% vs 14%). CONCLUSIONS Although in this study minimally invasive decompression led to less and slower improvement in patients ≥ 80 years of age compared with their younger counterparts, there was significant improvement compared with the preoperative baseline.
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Affiliation(s)
- Pratyush Shahi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Junho Song
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Sidhant Dalal
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | | | - Daniel J Shinn
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Kasra Araghi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Eric Mai
- 2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
| | - Evan Sheha
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - James Dowdell
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
| | - Sheeraz A Qureshi
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
| | - Sravisht Iyer
- 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.,2Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, New York
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20
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Khalilullah T, Tummala S, Panchal R. Spondylolisthesis and Idiopathic Sarcopenia Treated With Minimally Invasive Surgery for Transforaminal Lumbar Interbody Fusion: A Case Study and Literature Review. Cureus 2022; 14:e25086. [PMID: 35719769 PMCID: PMC9203043 DOI: 10.7759/cureus.25086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia is a muscle-wasting disease common among older adults. The condition has been associated with adverse perioperative and postoperative outcomes following spinal surgery. The combination of this muscle-wasting syndrome and spondylolisthesis and how we approached the case makes it a compelling study for surgeons attempting to treat this patient population more effectively. In this case study, we examine a 76-year-old male patient with chronic sarcopenia who needed transforaminal lumbar interbody fusion (TLIF) surgery for his grade 1 L4-5 spondylolisthesis, L4-5 degenerative disc disease, bilateral facet effusions and lumbosacral radiculopathy with active and chronic denervation. He consulted our neurosurgeon for his back pain and left lower extremity paresthesia. Magnetic resonance imaging (MRI) showed degenerative disc disease with bilateral facet effusion in multiple levels of the lumbar spine as well as broad disc bulge in L5-S1. Due to the patient’s past medical history of muscle wasting disease, a muscle biopsy of the left quadriceps was performed and revealed rare denervated fibers indicative of sarcopenia. Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) was performed as the most optimal surgical method for this condition. The patient experienced a massive decline in his VAS score from 9/10 to 0/10 two months from surgery, reflecting the fast wound healing process and recovery. Postoperatively, the AP X-ray of the lumbar spine showed dextroscoliosis and stable L4/5 TLIF instrumentation. The surgeon provided the patient guidance regarding his nutrition and exercise to maximize the treatment. This case illustrates the employment of the minimally invasive surgery (MIS) approach to diminish complications and tissue trauma of patients with sarcopenia and spondylolisthesis who are undergoing lumbar spine surgery.
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21
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The Influence of Self-Identified Gender on Clinical Outcomes and Post-operative Patient Satisfaction Following Lumbar Decompression: Cohort Matched Analysis. World Neurosurg 2022; 160:e616-e627. [DOI: 10.1016/j.wneu.2022.01.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
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Gradin APT, Rossoni KM, Bonato L, Zanon IDB, Batista Junior JL, Jacob Junior C, Cardoso IM. CURRENT RESULTS OF CONVENTIONAL LUMBAR ARTHRODESIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212004250509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the peri- and postoperative results and clinical repercussions in patients undergoing decompression surgery and single-level lumbar arthrodesis using the traditional technique (OTLIF) and to compare with the results of minimally invasive techniques (MITLIF) described in the literature. Methods: Our sample consisted of 22 patients who underwent TLIF surgery using the open technique (OTLIF) in the period October 2019 to January 2021, in our hospital. We compared the patients’ functional clinical results using the Oswestry scale in the preoperative period and 15 days after surgery, analyzed variables related to the perioperative period: surgery time, length of hospital stay, blood loss, use of a suction drain, and admission to the ICU, and compared these with the results reported in the literature for patients treated by the MITLIF technique. Results: The average age was 48.95 years and the most operated level was L4-L5 (55%). The average surgery time was 112.63 min. We did not use a suction drain in the postoperative period, there was no need for a blood transfusion in any patient, and no patient was admitted to the ICU. The average hospital stay was 1 day. Regarding the Oswestry Disability Index, the mean preoperative score was 44.73 and after 15 days, it was 24.05. Conclusions: surgical treatment using the OTLIF technique for single-level lumbar degenerative disease showed largely positive results, with improvement in disability scores, short hospital stay and low incidence of complications. When properly indicated, OTLIF is an excellent and safe option for the treatment of degenerative lumbar disease. Level of evidence IV; Case series study.
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Affiliation(s)
| | | | - Laísa Bonato
- Hospital Santa Casa de Misericórdia de Vitória, Brazil
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Adamska O, Modzelewski K, Stolarczyk A, Kseniuk J. Is Kummell's Disease a Misdiagnosed and/or an Underreported Complication of Osteoporotic Vertebral Compression Fractures? A Pattern of the Condition and Available Treatment Modalities. J Clin Med 2021; 10:2584. [PMID: 34208124 PMCID: PMC8230888 DOI: 10.3390/jcm10122584] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/22/2021] [Accepted: 06/08/2021] [Indexed: 01/18/2023] Open
Abstract
This narrative review provides the outcomes of minimally invasive surgery (MIS) and describes the available conservative treatment options for patients with osteoporotic vertebral compression fractures (OVCFs) that have risk factors for Kummell's disease (KD). It aims to explore the evidence, emphasize the possible therapy complications, and aims to propose the most efficient clinical strategies for maintaining a good overall condition of individuals who may suffer from neurological deficits from a late-diagnosed OVCF complication. The secondary objective is to sum up the diagnostic particularities concerning individuals prone to OVCFs and KD, as the major risk factor for developing these severe conditions remains osteoporosis. Findings of our narrative review are based on the results found in PubMed, Embase, and Google Scholar from the beginning of their inception to December 2020, described independently by two authors. All of the studies included in the review focus on reporting the following treatment methods: conservative methods, vertebroplasty, kyphoplasty, targeted percutaneous vertebroplasty, frontal and side-opening cannula vertebroplasty, SpineJack, bone-feeling mesh container treatment, and the difference in the cement viscosity used (high vs. low) and the approach used (unilateral vs. bilateral). The comparison of randomized control trials (RCTs) as well as prospective and retrospective case series showed a comparable efficacy of kyphoplasty and vertebroplasty, and described cement-augmented screw fixation and the SpineJack system as effective and safe. Although it should be noted that several studies revealed inconsistent results in regards to the efficacy of using back braces and analgesics in patients who had vertebral fractures that were overlooked or not enrolled in any active surveillance program to track the patient's deterioration immediately. Nevertheless there are non-standardized guidelines for treating patients with OVCFs and their complications already established. Using these guidelines, a treatment plan can be planned that takes into consideration the patients' comorbidities and susceptibilities. However, the primary approach remains the management of osteoporosis and that is why prophylaxis and prevention play a crucial role. These measures reduce the risk of disease progression. Unfortunately, in the majority of cases these measures are not taken into account and KD develops.
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Affiliation(s)
- Olga Adamska
- Collegium Medicum, University of Zielona Góra, 28 Zyty St., 65-046 Zielona Góra, Poland
| | - Krzysztof Modzelewski
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland; (K.M.); (A.S.)
| | - Artur Stolarczyk
- Orthopaedic and Rehabilitation Department, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland; (K.M.); (A.S.)
| | - Jurij Kseniuk
- Carolina Medical Center, 78 Pory St., 02-757 Warsaw, Poland;
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Kundra S, Gupta R, Luthra N, Dureja M, Katyal S. Effects of ventilation mode type on intra-abdominal pressure and intra-operative blood loss in patients undergoing lumbar spine surgery: A randomised clinical study. Indian J Anaesth 2021; 65:S12-S19. [PMID: 33814585 PMCID: PMC7993040 DOI: 10.4103/ija.ija_706_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/25/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIMS The aim of the study was to evaluate the effect of mode of mechanical ventilation; pressure-controlled ventilation (PCV) vs. volume-controlled ventilation (VCV) on airway pressures, intra-abdominal pressure (IAP) and intra-operative surgical bleeding in patients undergoing lumbar spine surgery. METHODS This was a prospective, randomised study that included 50 American Society of Anesthesiologists class I and II patients undergoing lumbar spine surgery who were mechanically ventilated using PCV or VCV mode. The respiratory parameters (peak and plateau pressures) and IAP were measured after anaesthesia induction in supine position, 10 min after the patients were changed from supine to prone position, at the end of the surgery in prone position, and after the patients were changed from prone to supine position. The amount of intraoperative surgical bleeding was measured by objective and subjective methods. RESULTS The primary outcome was the amount of intraoperative surgical bleeding. It was significantly less in the PCV group than in the VCV group (137 ± 24.37 mL vs. 311 ± 66.98 mL) (P = 0.000). Similarly, on comparing other parameters like peak inspiratory pressures, plateaupressures and IAP, the patients in PCV group had significantly lower parameters than those in VCV group (P < 0.05). No harmful events were recorded. CONCLUSION In patie,nts undergoing lumbar spine surgery, use of PCV mode decreased intraoperative surgical bleeding, which may be related to lower intraoperative respiratory pressures and IAP.
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Affiliation(s)
- Sandeep Kundra
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rekha Gupta
- Department of Anaesthesia, PGIMER, Chandigarh, India
| | - Neeru Luthra
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Mehak Dureja
- Department of Anaesthesia, Maharishi Markandeshwar (Deemed University), Mullana, Ambala, Haryana, India
| | - Sunil Katyal
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Kanaan T, Abusaleh R, Abuasbeh J, Al Jammal M, Al-Haded S, Al-Rafaiah S, Kanaan A, Alnaimat F, Khreesha L, Al Hadidi F, Al-Sabbagh Q. The Efficacy of Therapeutic Selective Nerve Block in Treating Lumbar Radiculopathy and Avoiding Surgery. J Pain Res 2020; 13:2971-2978. [PMID: 33239905 PMCID: PMC7680787 DOI: 10.2147/jpr.s276331] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Selective nerve root block (SNRB) is a procedure that can be used as a diagnostic or a therapeutic method. SNRB can be used in multiple sites, including cervical and lumbar . Our study aims to investigate the clinical effectiveness of the use of fluoroscopically guided therapeutic selective nerve root block as a non-surgical symptom management of lumbar radiculopathy. Patients and Methods This is a prospective study of therapeutic nerve root block in 76 patients with low back pain and/or sciatica at Jordan University Hospital. Data was collected by independent clinical interviewers, and visual analogue score (VAS) was used to measure pain severity. Results A total of 76 patients, 25 (32.8%) males and 51 (67.2%) females, underwent SNRB. 69 (90.7%) patients improved immediately after the procedure. Out of the total, 22 (28.9%) patients showed a long-term relief of symptoms and did not experience any recurrence during the three months of follow-up, while 47 (61.8%) experienced a recurrence of pain. In patients experiencing recurrence of symptoms, 35 needed surgery. Conclusion Therapeutic SNRB is an important procedure in the pain management of patients with lumbar radiculopathy caused by lumbar disc prolapse and foraminal stenosis. Our study showed that avoidance of surgery was achieved in up to 54% of patients; pain relief for at least 6 months was achieved in up to 29% of patients after a single SNRB. This makes it a very good second line of management after conservative treatment and a possible method to delay, and sometimes cease, the need for surgery.
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Affiliation(s)
- Tareq Kanaan
- Division of Neurosurgery & Spine Unit, Special Surgery Department, University of Jordan, Amman, Jordan
| | - Rami Abusaleh
- School of Medicine, University of Jordan, Amman, Jordan
| | | | | | - Sara Al-Haded
- School of Medicine, University of Jordan, Amman, Jordan
| | | | - Ali Kanaan
- School of Medicine, University of Jordan, Amman, Jordan
| | - Fatima Alnaimat
- Internal Medicine Department, University of Jordan, Amman, Jordan
| | - Lubna Khreesha
- Special Surgery Department, University of Jordan, Amman, Jordan
| | - Fadi Al Hadidi
- Division of Orthopedic Surgery & Spine Unit, Special Surgery Department, University of Jordan, Amman, Jordan
| | - Qussay Al-Sabbagh
- Division of Neurosurgery & Spine Unit, Special Surgery Department, University of Jordan, Amman, Jordan
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Louie PK, Vaishnav AS, Qureshi SA. Commentary: Relationship Between Preoperative Opioid Use and Postoperative Pain in Patients Undergoing Minimally-Invasive Stand-Alone Lateral Lumbar Interbody Fusion. Neurosurgery 2020; 87:E625-E627. [PMID: 32521020 DOI: 10.1093/neuros/nyaa236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medical College, New York, New York
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Abstract
STUDY DESIGN A retrospective subgroup analysis of a prospective observational study was carried out. SUMMARY OF BACKGROUND DATA Patients' baseline characteristics may influence the clinical outcomes after minimally invasive lumbar interbody fusion (MILIF). OBJECTIVE This study aimed to investigate the influence of patient's age and body mass index (BMI) on the clinical outcomes of MILIF for degenerative lumbar disorder. MATERIALS AND METHODS A total of 252 patients underwent MILIF. The clinical outcomes, including time to first ambulation, time to postsurgical recovery, back/leg pain in visual analog scale, Oswestry Disability Index, and EuroQol-5 Dimension, were collected at baseline, 4 weeks, 6, and 12 months. Patients were subgrouped by age (50 y and below: N=102; 51-64 y: N=102; 65 y and above: N=48) and BMI (≤25.0: N=79; 25.1-29.9: N=104; ≥30.0: N=69). Data from baseline to 12 months were compared for all clinical outcomes within age/BMI subgroups. Adverse events (AEs) and serious adverse events (SAEs) were summarized by age and BMI subgroups. RESULTS All age and BMI subgroups showed significant improvements in clinical outcomes at 12 months compared with the baseline. The median time to first ambulation was similar for all subgroups (age groups: P=0.8707; BMI: P=0.1013); older people show a trend of having longer time to postsurgical recovery (age groups: P=0.0662; BMI: P=0.1591). Oswestry Disability Index, back, and leg pain visual analog scale, and EuroQol-5 Dimension were similar in all subgroups at every timepoint. A total of 50 AEs (N=39) were reported, 9 of which were SAEs; 3 AEs and 1 SAE were considered to be related to surgical procedure. No differences were observed in safety by age groups and BMI groups. CONCLUSION MILIF appears to be safe and effective, independent of age or weight in the treatment of degenerative lumbar disorder. LEVEL OF EVIDENCE Level II.
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28
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Manson N, El-Mughayyar D, Bigney E, Richardson E, Abraham E. Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required. Adv Orthop 2020; 2020:7949216. [PMID: 32802519 PMCID: PMC7415111 DOI: 10.1155/2020/7949216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/04/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Percutaneous stabilization for spinal trauma confers less blood loss, reduces postoperative pain, and is less invasive than open stabilization and fusion. The current standard of care includes instrumentation removal. OBJECTIVE 1. Reporting patient outcomes following minimally invasive posterior percutaneous pedicle screw-rod stabilization (PercStab). 2. Evaluating the results of instrumentation retention. METHODS A prospective observational study of 32 consecutive patients receiving PercStab without direct decompression or fusion. Baseline data demographics were collected. Operative outcomes of interest were operative room (OR) time, blood loss, and length of hospital stay. Follow-up variables of interest included patient satisfaction, Numeric Rating Scales for Back and Leg (NRS-B/L) pain, Oswestry Disability Index (ODI), and return to work. Clinical outcome data (ODI and NRS-B/L) were collected at 3, 12, 24 months and continued at a 24-month interval up to a maximum of 8 years postoperatively. RESULTS 81.25% of patients (n = 26) retained their instrumentation and reported minimal disability, mild pain, and satisfaction with their surgery and returned to work (mean = 6 months). Six patients required instrumentation removal due to prominence of the instrumentation or screw loosening, causing discomfort/pain. Instrumentation removal patients reported moderate back and leg pain until removal occurred; after removal, they reported minimal disability and mild pain. Neither instrumentation removal nor retention resulted in complications or further surgical intervention. CONCLUSIONS PercStab without instrumentation removal provided high patient satisfaction, mild pain, and minimal disability and relieved the patient from the burden of finances and resources allocation of a second surgery.
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Affiliation(s)
- Neil Manson
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick E2L 4L4, Canada
- Saint John Regional Hospital, Horizon Health Network, 400 University Ave, PO Box 2100, Saint John, New Brunswick E2L 4L4, Canada
- Department of Surgery, Dalhousie University, 100 Tucker Park Rd, Saint John, New Brunswick E2K 5E2, Canada
| | - Dana El-Mughayyar
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick E2L 4L4, Canada
| | - Erin Bigney
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick E2L 4L4, Canada
| | - Eden Richardson
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick E2L 4L4, Canada
| | - Edward Abraham
- Canada East Spine Centre, Saint John Regional Hospital, 400 University Ave, PO Box 2100, Saint John, New Brunswick E2L 4L4, Canada
- Saint John Regional Hospital, Horizon Health Network, 400 University Ave, PO Box 2100, Saint John, New Brunswick E2L 4L4, Canada
- Department of Surgery, Dalhousie University, 100 Tucker Park Rd, Saint John, New Brunswick E2K 5E2, Canada
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Massel DH, Mayo BC, Shifflett GD, Bohl DD, Louie PK, Basques BA, Long WW, Modi KD, Hijji FY, Narain AS, Singh K. Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Isthmic Versus Degenerative Spondylolisthesis. Int J Spine Surg 2020; 14:115-124. [PMID: 32355615 DOI: 10.14444/7015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is a common surgical procedure for treatment of degenerative spondylolisthesis (DS) but remains controversial for treatment of isthmic spondylolisthesis (IS). Few studies have compared IS and DS outcomes after MIS TLIF. Therefore, the objective of the current study was to compare outcomes of patients with IS and DS after MIS TLIF. Methods A retrospective cohort analysis was performed on a prospectively maintained database of patients who underwent a primary, 1-level MIS TLIF for grade I or II IS or DS. Grade I and II DS and grade I IS patients were treated with MIS TLIF via a unilateral tubular approach, whereas the grade II IS patients were treated via a bilateral tubular approach. Differences in patient demographics and preoperative characteristics were assessed using independent sample t tests and χ2 tests. The type of spondylolisthesis and its effect on postoperative outcomes was analyzed using Poisson regression with robust error variance (binary outcomes) or linear regression (continuous outcomes) adjusted for preoperative characteristics. Subgroup analysis comparing grade I IS versus DS and grade II IS versus DS was performed. Results A total of 223 patients were included (IS: 62 [27.8%]; DS: 161 [72.2%]). IS patients were younger (P < .001), had a lower comorbidity burden (P < .001), and a greater incidence of grade II spondylolisthesis (P < .001) at L5-S1 (P < .001) than the DS cohort. Patients with IS experienced longer operative times (P < .001) and lower, but not statistically significant, arthrodesis rates compared to the DS cohort. No differences were observed in the remaining preoperative patient characteristics, perioperative or postoperative outcomes. Conclusions Despite being younger and having a lower comorbidity burden than the DS cohort, similar outcomes were observed after MIS TLIF for IS patients. Level of Evidence 3. Clinical Relevance These results suggest MIS TLIF is an appropriate treatment option for IS patients despite the increased instability inherent with IS.
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Affiliation(s)
- Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Benjamin C Mayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Grant D Shifflett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - William W Long
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Krishna D Modi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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30
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Massel DH, Mayo BC, Long WW, Modi KD, Lopez GD, Shifflett GD, Basques BA, Louie PK, Bohl DD, Hijji FY, Narain AS, Singh K. Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison of Grade I Versus Grade II Isthmic Spondylolisthesis. Int J Spine Surg 2020; 14:108-114. [PMID: 32355614 DOI: 10.14444/7016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is often used to treat low-grade isthmic spondylolisthesis (IS). No studies have compared surgical outcomes for grade I and II IS following MIS-TLIF. Therefore, the objective of the current study was to compare outcomes between patients with grade I and II IS following MIS-TLIF. Methods A retrospective cohort analysis was performed on a prospectively maintained database of patients who underwent a primary 1-level MIS-TLIF for treatment of IS between 2007 and 2015. Grade I patients underwent a unilateral tubular approach with a single interbody cage and bilateral pedicle screw instrumentation. Grade II patients underwent a bilateral tubular approach with bilateral interbody cage and pedicle screw placement. Baseline patient demographics and characteristics were compared using Student t test and χ2 analysis. Differences in peri- and postoperative outcomes were assessed using Poisson regression with robust error variance or linear regression adjusted for perioperative variables. Results A total of 58 patients with IS underwent MIS-TLIF; 21 (36.2%) were grade I and 37 (63.8%) were grade II. The grade I cohort was younger (42.2 versus 50.6 years, P = .029); no other differences in preoperative variables were observed. No significant differences in operative time, estimated blood loss, length of hospital stay, postoperative visual analogue scale scores, or complication and revision rates were demonstrated between cohorts. Arthrodesis rate was lower in the grade I cohort, though not statistically significant. Conclusions Despite the grade I cohort being younger with less-severe diagnoses, the grade II cohort experienced similar outcomes. This finding may be due to the grade II cohort receiving bilateral cages, potentially providing a better fusion environment. Clinical Relevance These results suggest that MIS-TLIF provides sufficient stabilization and fusion for treatment of grade II IS despite increased vertebral body displacement. In addition, MIS-TLIF with bilateral approach and interbody cage placement should be examined for treatment of high-grade IS cases.
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Affiliation(s)
- Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Benjamin C Mayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - William W Long
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Krishna D Modi
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Gregory D Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Grant D Shifflett
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, Illinois
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Katzell JL. Risk factors predicting less favorable outcomes in endoscopic lumbar discectomies. JOURNAL OF SPINE SURGERY 2020; 6:S155-S164. [PMID: 32195424 DOI: 10.21037/jss.2019.11.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Endoscopic lumbar discectomy was among the first minimally invasive spine procedures commonly performed. As such, all the benefits of minimal invasion were seen, including less pain, less soft tissue destruction, and faster recovery. While outcomes compare favorably to micro and open discectomy, not all patients fare equally well. This paper examines independent risk factors to assess their correlation to suboptimal outcomes after endoscopic lumbar discectomy. Methods Retrospective analysis of clinical outcomes of 55 consecutive patients treated with endoscopic discectomy between June 2018 and March 2019 by the author. Primary outcome measures were postoperative reductions of visual analog score (VAS) for back and leg pain modified MacNab criteria as well as time to narcotic independence. Risk factors examined included smoking, facet disease, adjacent segments disc degeneration, obesity, alcohol abuse, and psychiatric illness. Results There were 31 males and 24 females with a mean age of 41.76±12.53. Most patients suffered from contained herniations (49.1%) followed by extruded herniations (18.2%). Follow-up ranged from 6-18 months. The most common surgical levels were L5-S1 level (30.9%), L4-S1 (29.1%), and L4-5 (25.5%). The mean return to work (RTW) was 23.83±26.01 weeks. The average body mass index (BMI) was 29.11±4.75. The average time for narcotic independence was 9.64±7.29 days. MacNab outcomes showed that 47.3% (26/55) had excellent, 36.4% good (20/55), 12.7% fair (7/55), and 3.6% had poor (2/55), respectively. The VAS scores for the back (7.69 to 2.65) and leg (6.78 to 2.65) pain reduced significantly (P<0.0001). Smoking (P=0.048), psychiatric disease (P=0.029), disc herniations larger than 10 mm, facet disease, obesity (BMI >30), diabetes, and alcohol abuse was associated with fair and poor MacNab outcomes. Conclusions Endoscopic lumbar discectomy safely and reliably reduces axial pain and radiculopathy from lumbar disc herniations. Risk factors associated with incomplete pain relief are large herniations, obesity, instability, smoking, advanced facet degeneration, and decreased ability to cope with the surgery.
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Affiliation(s)
- Jeffrey L Katzell
- Minimally Invasive Spine & Joint Center Lake Worth, Lake Worth, FL, USA
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Areias B, Caetano SC, Sousa LC, Parente M, Jorge RN, Sousa H, Gonçalves JM. Numerical simulation of lateral and transforaminal lumbar interbody fusion, two minimally invasive surgical approaches. Comput Methods Biomech Biomed Engin 2020; 23:408-421. [PMID: 32189515 DOI: 10.1080/10255842.2020.1734579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study aims to compare spinal stability after two different minimally invasive techniques, the lateral lumbar interbody fusion (LLIF) and the transforaminal lumbar interbody fusion (TLIF) approaches. Two nonlinear three-dimensional finite element (FE) models of the L4-L5 functional spinal unit (FSU) were subjected to the loads that usually act on the lumbar spine. Findings show that the LLIF approach yields better results for torsion load case, due to the larger surface area of the implant. For extension, flexion and lateral bending loads, the TLIF approach presents smaller displacements probably due to the anterior placement of the cage and to the smaller damaged area of the annulus fibrosus.
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Affiliation(s)
- B Areias
- INEGI/DEMec, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal
| | - S C Caetano
- MEB, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal
| | - L C Sousa
- INEGI/DEMec, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal
| | - M Parente
- INEGI/DEMec, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal
| | - R N Jorge
- INEGI/DEMec, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal
| | - H Sousa
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J M Gonçalves
- Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
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Fidalgo DS, Areias B, Sousa LC, Parente M, Jorge RN, Sousa H, Gonçalves JM. Minimally invasive transforaminal and anterior lumbar interbody fusion surgery at level L5-S1. Comput Methods Biomech Biomed Engin 2020; 23:384-395. [PMID: 32096422 DOI: 10.1080/10255842.2020.1731482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This paper presents a finite element analysis to investigate the biomechanical changes caused by transforaminal (TLIF) and anterior lumbar interbody fusion (ALIF) at the L5-S1 level, applying two different implants: T_PAL (TLIF) and SynFix (ALIF). The main objective is to determine which one is more stable for patients. Numerical simulations of segmental motion show that, in the early postoperative phase, displacements and rotation angles obtained in ALIF are greater than the corresponding ones obtained in TLIF, as well as the principal stress values on the ligaments. So, TLIF performed with T_PAL is more stable than ALIF, especially during the recovery phase.
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Affiliation(s)
- D S Fidalgo
- INEGI/DEMec, FEUP, Universidade do Porto, Porto, Portugal
| | - B Areias
- INEGI/DEMec, FEUP, Universidade do Porto, Porto, Portugal
| | - L C Sousa
- INEGI/DEMec, FEUP, Universidade do Porto, Porto, Portugal
| | - M Parente
- INEGI/DEMec, FEUP, Universidade do Porto, Porto, Portugal
| | - R N Jorge
- INEGI/DEMec, FEUP, Universidade do Porto, Porto, Portugal
| | - H Sousa
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Hashemi M, Dadkhah P, Taheri M, Katibeh P, Asadi S. Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel ®) versus percutaneous laser disc decompression in patients with chronic radicular low back pain. Korean J Pain 2020; 33:66-72. [PMID: 31888320 PMCID: PMC6944373 DOI: 10.3344/kjp.2020.33.1.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/07/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background Low back pain secondary to discopathy is a common pain disorder. Multiple minimally invasive therapeutic modalities have been proposed; however, to date no study has compared percutaneous laser disc decompression (PLDD) with intradiscal injection of radiopaque gelified ethanol (DiscoGel®). We are introducing the first study on patient-reported outcomes of DiscoGel® vs. PLDD for radiculopathy. Methods Seventy-two patients were randomly selected from either a previous strategy of PLDD or DiscoGel®, which had been performed in our center during 2016-2017. Participants were asked about their numeric rating scale (NRS) scores, Oswestry disability index (ODI) scores, and progression to secondary treatment. Results The mean NRS scores in the total cohort before intervention was 8.0, and was reduced to 4.3 in the DiscoGel® group and 4.2 in the PLDD group after 12 months, which was statistically significant. The mean ODI score before intervention was 81.25% which was reduced to 41.14% in the DiscoGel® group and 52.86% in the PLDD group after 12 months, which was statistically significant. Between-group comparison of NRS scores after two follow-ups were not statistically different (P = 0.62) but the ODI score in DiscoGel® was statistically lower (P = 0.001). Six cases (16.67%) from each group reported undergoing surgery after the follow-up period which was not statistically different. Conclusions Both techniques were equivalent in pain reduction but DiscoGel® had a greater effect on decreasing disability after 12 months, although the rate of progression to secondary treatments and/or surgery was almost equal in the two groups.
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Affiliation(s)
- Masoud Hashemi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payman Dadkhah
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Taheri
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Katibeh
- Department of Pediatric Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Asadi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yoo JS, Ahn J, Buvanendran A, Singh K. Multimodal analgesia in pain management after spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:S154-S159. [PMID: 31656869 DOI: 10.21037/jss.2019.05.04] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Multimodal analgesia (MMA) is the simultaneous use of multiple analgesic medications that work in a synergistic manner to provide pain control. In recent years, spine surgery has seen the growth of multimodal perioperative protocols for managing pain. Postoperative pain following spinal procedures is a common complaint, with persistent pain even after the immediate convalescent period leading to negative impacts on health. A multidisciplinary approach is essential in reducing postoperative morbidity and complication rates. This review demonstrates the efficacy in the combined use of opioid-alternative medications such as NSAIDs, gabapentinoids, local anesthetics, acetaminophen, and other neuromodulatory pharmacologic agents. Continued research will be essential in the optimization of the MMA protocol for treating patients who undergo spine procedures.
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Affiliation(s)
- Joon S Yoo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Junyoung Ahn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Fischer CR, Beaubrun B, Manning J, Qureshi S, Uribe J. Evidence Based Medicine Review of Posterior Thoracolumbar Minimally Invasive Technology. Int J Spine Surg 2019; 12:680-688. [PMID: 30619671 DOI: 10.14444/5085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Evaluate the current evidence in meta-analyses on posterior thoracolumbar minimally invasive surgery techniques and outcomes for degenerative conditions. Methods A systematic review of the literature from 1950 to 2015. Results The review of the literature yielded 34 meta-analysis studies evaluating posterior thoracolumbar minimally invasive techniques and outcomes for degenerative conditions. There were 11 studies included which investigated minimally invasive surgery (MIS) versus open posterior lumbar decompressions. There were 14 studies included which investigated MIS versus open posterior lumbar interbody fusions. Finally, there were 9 studies focused on navigation techniques and radiation safety within MIS procedures. Conclusions There are 34 meta-analysis studies evaluating minimally invasive to open thoracolumbar surgery for degenerative disease. The studies show a trend toward decreased estimated blood loss, decreased length of stay, decreased complications, similar fusion rates, improved accuracy, and decreased radiation when minimally invasive techniques are used.
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Affiliation(s)
| | | | | | | | - Juan Uribe
- University of South Florida, Tampa, Florida
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Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery at Level L5-S1. VIPIMAGE 2019 2019. [DOI: 10.1007/978-3-030-32040-9_47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Senker W, Gruber A, Gmeiner M, Stefanits H, Sander K, Rössler P, Pflugmacher R. Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit. Orthop Surg 2018; 10:192-197. [PMID: 30152613 DOI: 10.1111/os.12397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 02/21/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To review the surgical results and to identify possible parameters influencing the clinical outcomes in an unselected patient collective undergoing minimally invasive lumbar interbody fusion in a spinal care unit. METHODS A total of 229 adult patients who underwent minimally invasive lumbar spinal fusion between 2008 and 2016 were included in this retrospective analysis. Lumbar fusion was performed using transforaminal interbody fusion (TLIF) devices and posterolateral fusion. To eliminate confounding parameters, in all patients interbody fusion was indicated by lumbar degenerative pathologies, and surgery was performed using the same fusion device. Treatment efficacy was evaluated using scores describing pain (visual analogue scale [VAS]) and health impairment (EQ-5D, Oswestry Disability Index [ODI]). The influence of patient age, obesity, active smoking status, and co-morbidities on clinical outcome and perioperative complications was analyzed. RESULTS The patient population reviewed had improved VAS (P(leg pain) ≤ 0.0001, P(back pain) ≤ 0.0001), ODI (P ≤ 0.0001), EQ-VAS (P ≤ 0.0001), and EQ-5D subscales "mobility", "self-care", "pain", and "anxiety" (P(mobility) ≤ 0.0001, P(self-care) = 0.41, P(pain) ≤ 0.0001, P(anxiety) = 0.011) postoperatively. Neither advanced patient age, nor increased body mass index (BMI), hypertension, or active smoking status had a significantly limiting influence on the success of minimally invasive spinal surgeries (MIS). Duration of surgery strongly correlated with the number of spinal levels treated and with intraoperative blood loss (r = 0.774, P ≤ 0.0001, n = 208). Weak positive correlations were found between patient age and duration of surgery (r = 0.184, P = 0.005, n = 229), intraoperative blood loss (r = 0.165, P = 0.012, n = 229), and duration of hospitalization (r = 0.270, P ≤ 0.0001, n = 228), respectively. When compared to non-smokers, smokers were younger (P ≤ 0.0001), and had a significantly lower BMI (P = 0.001), shorter durations of surgery (P ≤ 0.0001), decreased intraoperative blood loss (P = 0.022), and shorter hospital stays (P = 0.006), respectively. Complications occurred in 17 patients (7%) and were not affected by patient age, BMI, hypertension, or active smoking status. CONCLUSION Minimally invasive spinal surgery is a safe and effective treatment option and may be superior to open surgery in subpopulations with significant co-morbidities and risk factors, such as elderly and obese patients as well as patients with an active smoking status.
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Affiliation(s)
- Wolfgang Senker
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Kepler University Linz, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Kepler University Linz, Linz, Austria
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Kepler University Linz, Linz, Austria
| | - Harald Stefanits
- Department of Neurosurgery, Kepler Universitaetsklinikum Neuromed Campus, Kepler University Linz, Linz, Austria
| | - Kirsten Sander
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Philipp Rössler
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Robert Pflugmacher
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
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Peltier C, Germaneau A, Dupré JC, Hesser F, Brèque C, Rigoard P, Vendeuvre T. Biomechanical analysis of different cross-link configurations spinal instrumentation systems: a preliminary study. Comput Methods Biomech Biomed Engin 2017; 20:157-158. [DOI: 10.1080/10255842.2017.1382909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - A. Germaneau
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ENSMA, Poitiers, France
| | - J. C. Dupré
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ENSMA, Poitiers, France
| | - F. Hesser
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ENSMA, Poitiers, France
| | - C. Brèque
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ENSMA, Poitiers, France
- ABS Lab,University of Poitiers, France
| | - P. Rigoard
- CHU La Milétrie, Poitiers, France
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ENSMA, Poitiers, France
| | - T. Vendeuvre
- CHU La Milétrie, Poitiers, France
- Institut Pprime UPR 3346, CNRS – Université de Poitiers – ENSMA, Poitiers, France
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Barbosa DC, Ângelos JSD, Macena GMJD, Magalhães FNDO, Fonoff ET. Effects of ozone on the pain and disability in patients with failed back surgery syndrome. Rev Assoc Med Bras (1992) 2017; 63:355-360. [PMID: 28614539 DOI: 10.1590/1806-9282.63.04.355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/04/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.
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Affiliation(s)
- Danilo Costa Barbosa
- Division of Functional Neurosurgery, Department of Neurology, Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.,Medical School, Universidade Anhembi Morumbi, São Paulo, SP, Brazil
| | - Jairo Silva Dos Ângelos
- Division of Functional Neurosurgery, Department of Neurology, Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | | | - Francisco Nêuton de Oliveira Magalhães
- Division of Functional Neurosurgery, Department of Neurology, Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Erich Talamoni Fonoff
- Division of Functional Neurosurgery, Department of Neurology, Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Shiels SM, Talley AD, McGough MAP, Zienkiewicz KJ, Kalpakci K, Shimko D, Guelcher SA, Wenke JC. Injectable and compression-resistant low-viscosity polymer/ceramic composite carriers for rhBMP-2 in a rabbit model of posterolateral fusion: a pilot study. J Orthop Surg Res 2017; 12:107. [PMID: 28697772 PMCID: PMC5504717 DOI: 10.1186/s13018-017-0613-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/28/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The challenging biological and mechanical environment of posterolateral fusion (PLF) requires a carrier that spans the transverse processes and resists the compressive forces of the posterior musculature. The less traumatic posterolateral approach enabled by minimally invasive surgical techniques has prompted investigations into alternative rhBMP-2 carriers that are injectable, settable, and compression-resistant. In this pilot study, we investigated injectable low-viscosity (LV) polymer/composite bone grafts as compression-resistant carriers for rhBMP-2 in a single-level rabbit PLF model. METHODS LV grafts were augmented with ceramic microparticles: (1) hydrolytically degradable bioactive glass (BG), or (2) cell-degradable 85% β-tricalcium phosphate/15% hydroxyapatite (CM). Material properties, such as pore size, viscosity, working time, and bulk modulus upon curing, were measured for each LV polymer/ceramic material. An in vivo model of posterolateral fusion in a rabbit was used to assess the grafts' capability to encourage spinal fusion. RESULTS These materials maintained a working time between 9.6 and 10.3 min, with a final bulk modulus between 1.2 and 3.1 MPa. The LV polymer/composite bone grafts released 55% of their rhBMP-2 over a 14-day period. As assessed by manual palpation in vivo, fusion was achieved in all (n = 3) animals treated with LV/BG or LV/CM carriers incorporating 430 μg rhBMP-2/ml. Images of μCT and histological sections revealed evidence of bone fusion near the transverse processes. CONCLUSION This study highlights the potential of LV grafts as injectable and compression-resistant rhBMP-2 carriers for posterolateral spinal fusion.
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Affiliation(s)
| | - Anne D. Talley
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN USA
| | | | | | | | | | - Scott A. Guelcher
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN USA
- Medtronic Spine LLC, Memphis, TN USA
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Joseph C. Wenke
- US Army Institute of Surgical Research, Fort Sam Houston, TX USA
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Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res 2017; 17:446. [PMID: 28655308 PMCID: PMC5488344 DOI: 10.1186/s12913-017-2398-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic low back pain is a common health problem for adult workers and causes an enormous economic burden. With the improvement of minimally invasive surgical techniques (MIS) in spinal fusion and the development of fusion devices, more lumbar operations are today being performed through a less invasive technique. When compared with open surgeries (OS), MIS has demonstrated better clinical outcomes including operation time, blood loss, complication rates and length of hospital stay. The aim of this review was to identify and summarize evidence on the time to return to work and the duration of post-operation narcotic use for patients who had lumbar spinal fusion operations using MIS and OS techniques. METHODS A systematic literature review was performed including studies identified from PubMed, EMBASE, the Cochrane Collaboration, and the Centre for Review and Dissemination (CRD) (January 2004–April 2014) for publications reporting on time to return to work and post-operation narcotic use after MIS or OS lumbar spinal fusion surgeries. RESULTS Out of a total of 36 included studies, 28 reported on the time to return to work and 17 on the narcotic use after MIS or OS. Four studies described the time to return to work directly comparing MIS and OS. Three studies, from the US, directly compared the duration of narcotic use between MIS- transforaminal lumbar interbody fusion (TLIF) and OS-TLIF. In addition to the time to return to work, 23 studies reported on the rate of return to work and the employment rate before and after surgery, and two Swedish studies presented sick leave data. CONCLUSION There is a gap of good quality data describing the time to return to work and narcotic use after lumbar spinal fusion operations using MIS or OS techniques. However, the current systematic literature review indicates that patients who have lumbar spinal fusion operations, with the MIS procedure, generally return to work after surgery more quickly and require less post-operation narcotics for pain control compared to patients who have OS.
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Affiliation(s)
- Xuan Wang
- Mapi Group, Klarabergsviadukten 90B, SE-111 64 Stockholm, Sweden
| | - Benny Borgman
- Spine & Biologics Medtronic International Trading SARL, Tolochenaz, Switzerland
| | - Simona Vertuani
- Mapi Group, Klarabergsviadukten 90B, SE-111 64 Stockholm, Sweden
| | - Jonas Nilsson
- Mapi Group, Klarabergsviadukten 90B, SE-111 64 Stockholm, Sweden
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Yin HP, Wang YP, Qiu ZY, Du ZC, Wu YM, Li SW. Comparison of safety and efficiency of microendoscopic discectomy with automatic nerve retractor and with nerve hook. Regen Biomater 2016; 3:319-322. [PMID: 27699062 PMCID: PMC5043153 DOI: 10.1093/rb/rbw029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 12/04/2022] Open
Abstract
This study compares the safety and efficiency of two techniques in microendoscopic discectomy (MED) for lumbar disc herniation. The two techniques are MED with automatic nerve retractor and MED with nerve hook which had been widely used for many years. The former involves a newly developed MED device which contains three parts to protect nerve roots during operation. Four hundred and twenty-eight patients underwent MED treatments between October 2010 and September 2015 were recruited and randomized to either intraoperative utilization of automatic nerve retractor (n = 315, group A) or application of nerve hook during surgery (n = 113, group B). Operation time and intraoperative bleeding volume were evaluated. Simultaneously, Visual Analogue Scales (VAS) and muscle strength grading were performed preoperatively, and 1, 2, 3 days, 1, 2 weeks, 3 and 6 months postoperatively. No dramatic difference of pain intensity was observed between the two groups before surgery and 6 months after surgery (P > 0.05). The operation time was shorter in group A (30.30 ± 1.89 min) than that in group B (59.41 ± 3.25 min). Group A (67.83 ± 13.14 ml) experienced a significant decrease in the amount of blood loss volume when compared with group B (100.04 ± 15.10 ml). There were remarkable differences of VAS score and muscle strength grading after postoperative 1, 2, 3 days, 1, 2 weeks and 3 months between both groups (P ≤ 0.05). MED with automatic nerve retractor effectively shortened operation time, decreased the amount of bleeding, down-regulated the incidence of nerve traction injury.
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Affiliation(s)
- He-Ping Yin
- The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010030, China
| | - Yu-Peng Wang
- The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010030, China
| | - Zhi-Ye Qiu
- The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010030, China
| | - Zhi-Cai Du
- The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010030, China
| | - Yi-Min Wu
- The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010030, China
| | - Shu-Wen Li
- The Second Affiliated Hospital, Inner Mongolia Medical University, Hohhot 010030, China
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Lee YC, Zotti MGT, Osti OL. Operative Management of Lumbar Degenerative Disc Disease. Asian Spine J 2016; 10:801-19. [PMID: 27559465 PMCID: PMC4995268 DOI: 10.4184/asj.2016.10.4.801] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/15/2016] [Indexed: 12/12/2022] Open
Abstract
Lumbar degenerative disc disease is extremely common. Current evidence supports surgery in carefully selected patients who have failed non-operative treatment and do not exhibit any substantial psychosocial overlay. Fusion surgery employing the correct grafting and stabilization techniques has long-term results demonstrating successful clinical outcomes. However, the best approach for fusion remains debatable. There is some evidence supporting the more complex, technically demanding and higher risk interbody fusion techniques for the younger, active patients or patients with a higher risk of non-union. Lumbar disc arthroplasty and hybrid techniques are still relatively novel procedures despite promising short-term and mid-term outcomes. Long-term studies demonstrating superiority over fusion are required before these techniques may be recommended to replace fusion as the gold standard. Novel stem cell approaches combined with tissue engineering therapies continue to be developed in expectation of improving clinical outcomes. Results with appropriate follow-up are not yet available to indicate if such techniques are safe, cost-effective and reliable in the long-term.
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Affiliation(s)
- Yu Chao Lee
- Spinal Surgery Unit, Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Orso Lorenzo Osti
- Calvary Health Care, North Adelaide Campus, North Adelaide, SA, Australia
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Wessell N, Khalil J, Zavatsky J, Ghacham W, Bartol S. Verification of nerve decompression using mechanomyography. Spine J 2016; 16:679-86. [PMID: 26940191 DOI: 10.1016/j.spinee.2016.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/04/2016] [Accepted: 02/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Assessment of nerve root decompression in surgery is largely based on visualization and tactile feedback. Often times, visualization can be limited, such as in minimally invasive surgery, and tactile feedback is a subjective assessment that makes the evaluation of successful nerve decompression difficult. Electromyography (EMG) has been proposed as an assessment tool, but EMG responses are often difficult to quantify. Alternatively, mechanomyography (MMG) provides a quantifiable response with high signal-to-noise ratio compared with EMG. MMG provides a sensitive tool to accurately quantify mechanical responses to motor action potentials generated by electrical stimulus, allowing more reliable assessment of nerve decompression. PURPOSE The aim of this study was to assess the ability of MMG to quantitatively demonstrate successful nerve root decompression. STUDY DESIGN Prospective cohort, Therapeutic Level III, Urban Level I Trauma Center. PATIENT SAMPLE A total of 46 patients (72 affected nerve roots) undergoing decompression procedures for lower extremity radiculopathy caused by nerve root compression were enrolled in the study. The study population included 15 patients with herniated nucleus pulposus (HNP) and 31 with lateral recess stenosis (LRS). OUTCOME MEASURE Visual analog scale (VAS) score. METHODS A total of 72 nerves roots in 46 patients undergoing lumbar decompression procedures, for lower extremity radicular symptoms, were tested using MMG. Nerves were stimulated upstream from the compression site, and the lowest threshold current needed to generate a muscle response was determined. Signal response sizes were recorded before and after decompression. VAS scores were collected pre- and postoperatively. RESULTS Of the patients, 90% (65/72) had elevated stimulation thresholds (>1 milliamp [mA]) before decompression. After decompression, 98% of patients (64/65) with elevated current thresholds exhibited a drop in threshold of ≥1 mA (p<.001). A postdecompression increase in response amplitude was recorded in all patients. VAS scores improved postdecompression (6.8 vs. 1.1, p<.001) with a positive correlation between decreased stimulation thresholds and degree of improvement in VAS scores (p<.001). CONCLUSION MMG is an effective tool that can be used to differentiate normal and compressed nerves by quantifying the mechanomyographic response to a stimulating current. MMG allows one to measure the effect of decompression, judge its effectiveness in real time, and eliminate the subjectivity seen in tactile feedback methods. When the adequacy of decompression is uncertain, MMG can guide the surgeon toward additional or alternative procedures to ensure complete nerve root decompression.
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Affiliation(s)
- Nolan Wessell
- Henry Ford Health System, 2799 West Grand Blvd. CFP-6, Detroit, MI 48202, USA.
| | - Jad Khalil
- Henry Ford Health System, 2799 West Grand Blvd. CFP-6, Detroit, MI 48202, USA
| | - Joseph Zavatsky
- Spine and Scoliosis Specialists, 14505 University Point Pl, Tampa, FL 33613, USA
| | - Wael Ghacham
- Henry Ford Health System, 2799 West Grand Blvd. CFP-6, Detroit, MI 48202, USA
| | - Stephen Bartol
- Henry Ford Health System, 2799 West Grand Blvd. CFP-6, Detroit, MI 48202, USA
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Parker SL, McGirt MJ, Bekelis K, Holland CM, Davies J, Devin CJ, Atkins T, Knightly J, Groman R, Zyung I, Asher AL. The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale. Neurosurg Focus 2015; 39:E4. [DOI: 10.3171/2015.9.focus15355] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meaningful quality measurement and public reporting have the potential to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. Recent developments in national quality reporting programs, such as the Centers for Medicare & Medicaid Services Qualified Clinical Data Registry (QCDR) reporting option, have enhanced the ability of specialty groups to develop relevant quality measures of the care they deliver. QCDRs will complete the collection and submission of Physician Quality Reporting System (PQRS) quality measures data on behalf of individual eligible professionals. The National Neurosurgery Quality and Outcomes Database (N2QOD) offers 21 non-PQRS measures, initially focused on spine procedures, which are the first specialty-specific measures for neurosurgery. Securing QCDR status for N2QOD is a tremendously important accomplishment for our specialty. This program will ensure that data collected through our registries and used for PQRS is meaningful for neurosurgeons, related spine care practitioners, their patients, and other stakeholders. The 2015 N2QOD QCDR is further evidence of neurosurgery’s commitment to substantively advancing the health care quality paradigm. The following manuscript outlines the measures now approved for use in the 2015 N2QOD QCDR. Measure specifications (measure type and descriptions, related measures, if any, as well as relevant National Quality Strategy domain[s]) along with rationale are provided for each measure.
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Affiliation(s)
| | - Matthew J. McGirt
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Kimon Bekelis
- 3Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Jason Davies
- 5Department of Neurological Surgery, State University of New York at Buffalo, New York
| | - Clinton J. Devin
- 6Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tyler Atkins
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Jack Knightly
- 7Department of Neurological Surgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Rachel Groman
- 8Clinical Affairs and Quality Improvement, Hart Health Strategies, Washington, DC; and
| | - Irene Zyung
- 9American Association of Neurological Surgeons, Rolling Meadows, Illinois
| | - Anthony L. Asher
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
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Jentzsch T, Sprengel K, Peterer L, Mica L, Werner CML. 3D navigation of endoscopic rhizotomy at the lumbar spine. J Clin Neurosci 2015; 23:101-105. [PMID: 26628214 DOI: 10.1016/j.jocn.2015.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/18/2015] [Indexed: 10/22/2022]
Abstract
We present a detailed description of the surgical technique and the preliminary results of an endoscopic denervation for patients with chronic low back pain (CLBP) originating from the facet joints (FJ). Endoscopic denervation of the medial branches of the dorsal rami supplying the FJ has recently been appraised as providing excellent intraoperative visualization and long term pain relief for these patients. Conventional endoscopic rhizotomy has been expanded to include a the precise localization of 3D navigation. A surgical description and the results of our first four patients treated with 3D navigated endoscopic rhizotomy (3DNER) are presented. Four patients with a mean age of 59years and a follow-up time of 2months were included. All patients reported pain reduction in the immediate postoperative period, while three patients (75%) had long lasting relief. The patient without persisting relief had previously sustained a lumbar disc prolapse and only achieved minor pain relief with preoperative FJ infiltration, compared to the significant relief that was seen in the other patients. In contrast to conventional rhizotomy, 3DNER enables the surgeon to ablate more precisely and extensively, which is especially useful if scar tissue is present from previous injuries or surgeries. When successful, this technique may provide long lasting pain relief, especially if the preoperative FJ infiltrations are followed by a substantial pain reduction.
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Affiliation(s)
- Thorsten Jentzsch
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Kai Sprengel
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Lorenz Peterer
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Ladislav Mica
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, Zürich 8091, Switzerland
| | - Clément M L Werner
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, Zürich 8091, Switzerland.
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MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 3:287-313. [DOI: 10.1007/s00586-015-3886-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/14/2022]
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